The White House issued a new report recently on the states’ progress in implementing health reform. The Affordable Care Act is an extensive, complex piece of legislation; the states must complete many steps on the way to full implementation of the law. Since the process is by no means over, think of this information as a progress report like you got in grade school. It highlights strengths and reveals areas where states need to work harder before the final exam (full exchange implementation will be January 1, 2014). Naturally, states are at different places on the timeline but the overall trends are very encouraging.

Forty-four states are participating in premium rate review, which forces insurers to justify any double-digit increases in premium costs. This review process has already protected purchasers. For example, in South Carolina, state review saved consumers up to $15 million total. (To the six states not doing premium reviews—Alabama, Arizona, Louisiana, Missouri, Montana and Wyoming—what are you waiting for? Your citizens need your help.)

The White House report also included a snapshot of ten states’ progress toward implementing the law. The profiled states are not necessarily the farthest along in implementing the law; instead they are used to highlight the diversity of approaches and political orientations of the states. These examples work to underscore the fact that health care truly is a bipartisan issue. As the Mississippi Commissioner of Insurance aptly noted, “A healthcare exchange is not a partisan political issue. Across this nation, Republicans and Democrats alike have embraced the concept of health exchanges as a way to help individuals and small businesses more easily obtain health insurance.”

However, just because it is a bipartisan issue doesn’t mean that everyone agrees on the best way to implement the exchanges. Many stakeholders are convinced that state-run exchanges are more ideal than the federal exchange. The Boise Chamber of Commerce stated that it supported a state-based exchange “[s]o that Idaho can maintain authority over the state’s private health market.” This concern was echoed by the Pennsylvania Department of Insurance, which noted that “Pennsylvania has determined that developing a state-based health insurance exchange will work best for Pennsylvania residents.” However, some states may feel unprepared or unwilling to run their own exchanges. Those states have several choices. There will be Partnership Exchanges, which will allow states to run certain elements of the exchange while the federal government runs the other functions. Arkansas plans to pursue this option. And even though many states are making progress on their own exchanges, there is a federal exchange in the works for those states that cannot or do not want to establish and run their own exchanges.

Just like students in a classroom, the states’ progress varies widely. However, overall the states are progressing towards implementation of the Affordable Care Act. Certain states are farther along in the process, but no one wants to be left behind!